DI 23060.020 Identifying Excluded Medical Sources of Evidence

A. Excluded medical sources of evidence must provide a written statement of exclusion

Excluded medical sources of evidence must provide a written statement of exclusion each time they furnish evidence to us directly or indirectly through a representative, claimant, or other individual or entity.

Adjudicators have no duty to identify excluded medical sources of evidence on their own. However, if there is no written statement of exclusion, and an adjudicator receives clear documentation that a source is an excluded medical source of evidence, the adjudicator must exclude the source’s evidence (unless there is sufficient information to apply a good cause exception(s)).

Additionally, if there is no written statement of exclusion, and an adjudicator receives clear documentation that a source is an excluded medical source of evidence, the adjudicator should refer the source to the Social Security Administration’s Office of the Inspector General (SSA’s OIG). See DI 23060.040 for how to refer an excluded medical source of evidence to SSA’s OIG.

An example of clear documentation is an email from an administrator or professional relations officer to all staff stating that John Doe, M.D., is an excluded medical source of evidence because he was convicted of a felony under section 208 of the Social Security Act (Act) on November 2, 2016.

The reason, effective date, and expected length of exclusion under section 1128 of the Act, and whether the Office of Inspector General of the Department of Health and Human Services (HHS’ OIG) has waived the exclusion; and

The date of the CMP, assessment, or both, for submitting false evidence under section 1129 of the Act.

If a written statement of exclusion does not include information that allows an adjudicator to determine whether a good cause exception(s) may apply, the adjudicator should contact the excluded medical source of evidence for clarification or additional information. See DI 22505.008 for instructions on developing supplemental evidence.